Application of Cone Beam Computed Tomography in Risk Assessment of Lower Third Molar Surgery

Radiographic Evaluation Factors That Influence the Decision of the Tooth Extraction Method

INTRODUCTION

A simple tooth extraction method usually involves using elevators and forceps to remove the tooth easily. In contrast, a surgical extraction method requires utilizing a straight handpiece to facilitate the tooth extraction, either removing bone or sectioning the tooth into pieces.

OBJECTIVE

In this research, we aim to diagnose a tooth radiographically before extraction and determine certain factors to observe which extraction method might be more feasible, either simple or surgical.

METHODOLOGY

This study followed a retrospective cross-sectional study design. The x-ray radiographs (periapical (PA) or panoramic) were collected from the R4 system in the university dental hospital for data collection. Different radiographic influencing factors were measured, such as bone density, bone level, endodontic involvement (RCT/post and core), crowned or remaining root, and root morphology. Statistical associations were performed using SPSS (IBM Corp., Armonk, NY) with a one-way ANOVA test.

RESULTS

There were 62 cases with 47 simple and 15 surgical extractions. There was a non-significant (p>0.05) association between the measured factors and the extraction method, either simple or surgical tooth extraction. Although bone density measurements showed a slight tendency toward PA lesions and simple tooth extraction.

CONCLUSION

There was no significant association between the factors and extraction methods. Future research is required to determine whether or not preoperative radiographic evaluation can influence the decision for the tooth extraction method.

Risk factors for impacted lower third molar root perforation through the undercut-shaped lingual plate: preoperative insights from panoramic radiography

This study aimed to identify risk factors associated with perforation of the undercut (U)-shaped lingual plate (LP) by the lower third molar (LM3) root using panoramic radiography (PAN). We retrospectively examined 468 impacted LM3s from 468 individuals, categorizing LM3-LP associations and LP morphology in the coronal section of cone-beam computed tomography as perforation or nonperforation and U-type or non-U-type, respectively. The outcome was the combination of perforation and U-type, and study variables included patient demographics (age and sex) and PAN-associated features (Winter's classification, Pell-Gregory classification, and two major Rood signs). Multivariate logistic regression methods were used for analysis. Perforated and U-type LPs were observed in 205 (43.8%) and 212 (45.3%) cases, respectively. The double-positive outcome was observed in 126 LM3s (26.9%). In the multivariate model, age ≥ 26 years [odds ratio (OR), 2.66; p = 0.002], men (OR, 2.01; p = 0.002), mesioangular (OR, 2.74; p = 0.038) and horizontal impaction (OR, 3.05; p = 0.019), and root darkening (OR, 1.73; p = 0.039) were independently associated with the risk. Class III impaction (OR, 0.35; p = 0.021) and interruption of the white line (OR, 0.55; p = 0.017) were negatively correlated with the risk. In conclusion, this study highlights the importance of identifying the higher probability of U-type LP perforation by the LM3 root in men aged over their midtwenties with Class I/II impaction and mesioangularly or horizontally impacted LM3s, along with root darkening and no interruption of the white line on PAN.

Imaging in Third Molar Surgery: A Clinical Update

Third molar surgery is one of the most common surgical procedures performed in oral and maxillofacial surgery. Considering the patient's young age and the often-elective nature of the procedure, a comprehensive preoperative evaluation of the surgical site, relying heavily on preoperative imaging, is key to providing accurate diagnostic work-up, evidence-based clinical decision making, and, when appropriate, indication-specific surgical planning. Given the rapid developments of dental imaging in the field, the aim of this article is to provide a comprehensive, up-to-date clinical overview of various imaging techniques related to perioperative imaging in third molar surgery, ranging from panoramic radiography to emerging technologies, such as photon-counting computed tomography and magnetic resonance imaging. Each modality's advantages, limitations, and recent improvements are evaluated, highlighting their role in treatment planning, complication prevention, and postoperative follow-ups. The integration of recent technological advances, including artificial intelligence and machine learning in biomedical imaging, coupled with a thorough preoperative clinical evaluation, marks another step towards personalized dentistry in high-risk third molar surgery. This approach enables minimally invasive surgical approaches while reducing inefficiencies and risks by incorporating additional imaging modality- and patient-specific parameters, potentially facilitating and improving patient management.